7.4 New developments in systemic treatment options
Many different cellular and molecular effectors are involved in AE. A
recent review summarizes important players in type 2 immunity in regards
to AE and Asthma [138]. The expanding knowledge of this complex type
2 immunological background of AE led to new developments of new
cytokine-directed treatment options that are currently under
investigation: Mepolizumab (anti-IL-5) treatment did not show an
clinical improvement of AE patients in short and longterm phase-2
clinical trial [139]. Antibodies interfering with IL-13
(lebrikizumab, tralokinumab) have shown promising results in ongoing
studies, while selective neutralization of IL-31 (nemolizumab) proved
efficacy in reducing itch, but only moderate EASI response [75].
Several more biologics and small molecules interfering with key
mediators of AE are currently in development and may contribute to
tailored therapeutic approaches in future [75]. An interesting
approach to improve AE in patients unresponsive to extensive therapy is,
to use repetitive transient reductions of total IgE, which lead in a
small number of patients to long‐lasting improvement of AE with
improvement of both clinical parameters as well as the quality of life
[140]. Additionally, downregulatory strategies for the immune system
are under investigation. CD300a expression has a downregulatory role in
AE (mice), thus could be an anti-inflammatory strategy [82]. The
immune system in epithelial cells is posttranscriptional regulated by
miRNAs [141]. Amongst others, miR-10a-5p has been identified to
modulate AE targets [142]. L‐type amino acid transporter 1 (LAT1) is
critical for activating human and mouse T cells and its inhibition
reveals a potential new target for AE treatment [143].
It is important to increase the knowledge about the complex mechanisms
influencing AE and therefore a combination of patient information
correlated with biomaterial analysis and in vitro testing is needed. The
CK-CARE program will contribute to identify and validate new and
reliable biomarkers for precision medicine [144].